Peanut sublingual immunotherapy in peanut-allergic children
What it found
In peanut-allergic children, daily under-the-tongue peanut drops for 48 months raised the amount of peanut protein most could tolerate without symptoms.
The effect lasted more than 17 weeks after treatment stopped.
What they found
Studies in people
Desensitization after treatment
The average amount of peanut protein tolerated rose from 48 mg at the start to 2723 mg after 48 months. 70% of children could tolerate at least 800 mg, and 36% could tolerate the full 5000 mg without symptoms.
Durability of effect
After stopping treatment for 1 to 17 weeks, the estimated median time to lose the ability to tolerate at least 800 mg was 22 weeks. No child reacted to less than 300 mg during the 17-week avoidance period.
Immune changes
Skin prick test size and levels of peanut-specific IgE dropped, while peanut-specific IgG4 rose. These changes appeared as early as 6 months and lasted through treatment.
Safety and side effects
About 4% of home doses caused symptoms, mostly short-lived itching in the mouth or throat. No dosing symptoms needed epinephrine. Three children stopped treatment because of stomach symptoms.
What the authors conclude
“In this open-label, prospective study, peanut SLIT was safe and induced clinically significant desensitization in most of the children, lasting more than 17 weeks after discontinuation of therapy.”
Also in their conclusions
- They conclude that peanut SLIT was safe and caused clinically significant desensitization in most children, lasting more than 17 weeks after treatment stopped.
- They say the protection against accidental peanut ingestion even after weeks without therapy supports the real-world feasibility of peanut SLIT.
- They suggest that peanut SLIT could be a promising treatment option for peanut allergy.
How it was done
The authors wanted to test a higher dose of peanut sublingual immunotherapy and see how long the protection lasts after stopping treatment.
They gave 54 peanut-allergic children aged 1 to 11 years daily under-the-tongue peanut drops for 48 months. After treatment, 37 children who responded well were randomly assigned to avoid the drops for 1 to 17 weeks before a final peanut challenge.
What it can’t tell you
- This was an open-label study, so participants and researchers knew who was getting treatment. That can affect how symptoms are reported.
- The study did not compare peanut SLIT to a placebo or to other treatments, so it cannot show how it compares to them.
- The results may not apply to children with the most severe anaphylaxis or severe asthma, who were not included.
Who paid
- Funding
- Funded by NIAID NIH HHS; NCATS NIH HHS; NCI NIH HHS; NCCIH NIH HHS (from the PubMed record).
- Conflicts
- Conflicts of interest: EHK reports scientific advisory board membership with ALK-Abello, DBV Technologies, Kenota Health and Ukko Inc; consultancy for AllerGenis, Allergy Therapeutics Ltd, Belhaven Pharma, Duke Clinical Research Institute, Genentech, and Nutricia; and receives grant support to his institution from the NIH-NIAID and FARE. CAK is an Associate Editor at JACI, is on the Board of the American Board of Allergy and Immunology, and receives royalties from UpToDate. MDK reports consultancy for Ukko, Inc and receives grant support to his institution from the NIH and DoD. AWB reports being a minority stock holder in Allertein and Mastcell Pharmaceuticals; scientific advisory board membership with Aimmune Therapeutics, Consortia TX and Prota Therapeutics; consultancy for ALK-Abello, Astellas Pharma, DBV Technologies, N-Fold LLC, Kaleo, Ukko Inc; royalties with UpToDate; and receives grant support to his institution from the NIH-NIAID, NIH-NCCIH, and FARE. The rest of the authors declare that they have no relevant conflicts of interest.
- Authors work at
- University of North Carolina School of Medicine, NC; Center for Drug Evaluation and Research, Md; University of North Carolina at Chapel Hill, NC
The paper
- Title
- Open-label study of the efficacy, safety, and durability of peanut sublingual immunotherapy in peanut-allergic children
- Type
- Randomised controlled trial
- Evidence
- Studies in people
- Summarised from
- Full text
- Cite
- Kim EH, Keet CA, Virkud YV, et al (2023). Open-label study of the efficacy, safety, and durability of peanut sublingual immunotherapy in peanut-allergic children. The Journal of allergy and clinical immunology. doi:10.1016/j.jaci.2023.01.036Free full textPubMed 36828080DOI
Summary written 26 Sep 2026. Check it against the paper before it changes what you eat. How we summarise papers · Report an error